Opioid painkiller prescriptions may run in families

A new pain medication being developed at Indiana University is showing promise.

When one person in a household gets prescribed opioids, the other people who live with them are more likely to get their own prescriptions for these narcotic painkillers, a U.S. study suggests.

Researchers examined data on about 12.6 million people living in a household where someone was prescribed opioids and 6.4 million individuals in homes where someone was prescribed a different option for pain – nonprescription steroidal anti-inflammatory (NSAID) drugs.

Overall, 11.83 percent of people living with someone prescribed opioids and 11.11 percent of people living with a person prescribed NSAIDs started taking opioids over the next year, the study found.

“We already know that patients often share their prescriptions for opioids with a family member,” said lead study author Marissa Seamans of the Johns Hopkins University Bloomberg School of Public Health in Baltimore. “What we didn’t know is whether family members of opioid users are more likely to fill opioid prescriptions themselves than family members of non-opioid users.”

The increase in absolute risk was small – less than one percentage point.

“But this matters for patients because millions of opioids are prescribed and have harmful effects,” Seamans said by email.

Opioid prescriptions in the U.S. surged by 300 percent from 1991 to 2009 and totaled 246 million by 2015, the researchers write in JAMA Internal Medicine.

To assess how one person’s prescription might influence others in their household, the study team looked at insurance claims from 2000 to 2014 for people who were living together and had the same benefits.

The rise in risk of opioid use with another user in the household was small across all age groups. It was greatest, at 1.26 percentage points, for adults aged 26 to 35 and it was lowest, at 0.41 percentage point, for children 11 or younger.

When the first person prescribed opioids had back or neck pain or a fracture, the risk that another person in their household would get opioids was slightly lower than when the first person didn’t get opioids for these reasons, the study also found.

One drawback of the study is that insurance claims don’t shed light on the reasons prescriptions for opioids might run in families.

“It is possible that this is due to increased rates of chronic pain in people with family members with chronic pain,” said Dr. Chad Brummett, a researcher at the University of Michigan in Ann Arbor and co-director of the Michigan Opioid Prescribing Engagement Network.

“However, it is also likely that living with an opioid user alters attitudes and beliefs about the risks and benefits of opioid use,” Brummett, who wasn’t involved in the study, said by email.

Even if opioids are used as prescribed, just having these drugs in the house increases the chances that somebody in the household may misuse opioids, said Dr. Julie Gaither, a pediatrics researcher at Yale School of Medicine in New Haven, Connecticut who wasn’t involved in the study.

“Opioids are now available in millions of American homes, which means that everyday individuals vulnerable to addiction and overdose – such as children, teens, the elderly, and those with a history of substance abuse – are routinely exposed to medications that are highly addictive and potentially deadly,” Gaither said by email.

“Simply having more of the medications around increases the risk for accidental poisonings in the young and overdose in teens and adults,” Gaither added.

The study findings add to evidence that opioids should be prescribed in the smallest dose possible for the briefest period of time, said Dr. Constance Houck, a researcher at Harvard Medical School and Boston Children’s Hospital who wasn’t involved in the study.

“This study reinforces the concerns that having more opioid medications in a household may put other family members at risk,” Houck said by email. “The take home message from this study is that opioids should be used sparingly for the treatment of pain and whenever possible combined with other medications such as NSAIDs and physical modalities such as ice or heat to reduce the amount needed.”